| NPI | 1588706600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 12073) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN733) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2023-05-25 |